Background: Feeding and swallowing difficulties (FSD) have been found in typically developing children as well as in children with complex medical conditions and developmental disabilities. These difficulties cause negative health consequences such as aspiration pneumonia, chronic lung disease, failure to thrive, prolonged hospital stay and even death. The early identification and management of feeding and swallowing difficulties is important as it prevents the negative effects on health and quality of life. Hence, there is a need for a validated screening tool to use in the general hospitalized paediatric population. Research Aims: The aim of this study was to validate the Feeding and Swallowing Questionnaire as a screening tool, in the paediatric population aged 0 – 2 years admitted to general medical wards. The secondary aim was to describe the FSD presenting in the paediatric population aged 0 - 2 years who are hospitalized in the general medical wards. Methodology: A prospective, descriptive, clinimetric design was utilized. A sample of 107 participants admitted to the general medical wards at Steve Biko Academic Hospital were included in the study. Participants’ feeding and swallowing was screened by a research assistant using the Feeding and Swallowing Questionnaire. After the screening, a clinical feeding and swallowing assessment was conducted for comparison, the assessment was conducted by the student researcher using the Clinical Feeding and Swallowing Assessment Tool. Results: There was a 27% FSD prevalence, with the majority of cases (92%) occurring in children under one year of age. One hundred and three children (63% male; median (IQR) age 5.2 (2.1 – 12.8) months) underwent screening and clinical assessment for feeding and swallowing disorders. The criterion validity of the Feeding and swallowing Questionnaire was established with a sensitivity of 88% and a specificity of 32%. Internal consistency was achieved with an acceptable Cronbach’s alpha of 0.79, and good inter-rater reliability (80%). Participants presented with feeding difficulties in all the phases of swallowing, while some participants had behavioural feeding difficulties. Those who had FSD had the following medical conditions: cardiorespiratory, neurological and gastrointestinal disorders namely acute gastroenteritis and liver disease. Feeding and swallowing difficulties were associated with increased mealtime duration (p=0.005) and supplementary oxygen support (p=0.03). Conclusion: The results confirm that the Feeding and Swallowing Questionnaire shows promising findings as a reliable and valid tool for the identification of FSD in the general hospitalized paediatric population. However, further research in other setting with general paediatric medical wards is required to increase the robustness of the screening tool.

Background: Feeding and swallowing difficulties (FSD) are found in typically developing children and children with complex medical and developmental conditions. These difficulties may have negative health consequences which can be stressful for caregivers as they are required to provide care for their children in the home environment. The Feeding and Swallowing Impact Survey (FS-IS) is a subjective rating scale used to determine the health-related quality of life (HRQoL) of caregivers of children diagnosed with FSD. However, this scale is not yet available in any of the official South African languages (except for English), and has not yet been culturally or linguistically adapted for the South African context. Research aims: The study aimed to cross culturally adapt and validate the FS-IS for the South African context by 1) describing the content validity of the FS-IS in a South African context; 2) describing the cultural and linguistic appropriateness of the English, isiXhosa and Afrikaans versions of the FS-IS; and 3) describing the experiences caregivers of children have in caring for their child with FSD using the FS-IS, in a pilot study. Methodology: A descriptive exploratory design was used to cross-culturally adapt and pilot the FS-IS, which consists of 3 subsections related to daily activities, worrying and problems with feeding. Five expert speech-language therapist (SLT) participants were identified to review the FS-IS for content validity. The FS-IS was then translated into Afrikaans and isiXhosa using the forward and back translation process. Caregivers (n=15) were identified at feeding clinics to determine the cultural and linguistic appropriateness of the FS-IS in English (n=5), Afrikaans (n=5) and isiXhosa (n=5). Their recommendations were taken into consideration and changes made. The pilot study included caregivers of children with FSD attending feeding clinics at two institutions (n=32) who completed the FS-IS. The participants in the pilot study included parents as primary caregivers (n=28; 88%), grandparents (n=2; 6%), as well as foster parents (n=2; 6%). Thirty-one participants were female with 14 English speaking, 9 isiXhosa and 9 Afrikaans speaking. The caregivers were the primary caregivers of children with a variety of FSD including non-oral feeds, oral feeds with specific modifications and picky or selective eaters. Results: The FS-IS was found to have content validity as experts and caregiver participants judged it to be contextually relevant for the South African context. Caregivers considered the items on the FSIS important, clear and appropriate for speakers of their native language as well as for fellow South African families, with minor changes suggested for the isiXhosa translated version. The tool has high internal consistency (Cronbach's alpha = 0.827) as well as excellent intra and inter-rater reliability (100% agreement). Daily activities that caregiver participants found most difficult included getting help from others (50%, n=16) and leaving their child in the care of others as they are scared to have others feed or take care of their child (62.5%, n=19). The majority of caregiver participants reported concerns related to their child's general health (84%, n=27) and whether they were doing enough to help with their child's FSD (50%, n=16). Few caregivers reported difficulties with feeding, with 87.5% (n=28) reporting no difficulties as a result of the time taken to prepare meals and 72% (n=23) reported no difficulty due to professionals or family having differing opinions about how to feed their child with FSD. Conclusion: The results confirm that the FS-IS is a reliable and valid tool for the identification of caregivers with reduced HRQoL related to caring for their child with FSD in a South African context. The adapted and translated FS-IS can therefore be used to identify caregivers who may need additional support or referral for further management from the multidisciplinary team. The results highlighted the complexity of caring for a child with FSD and the effects of the burden of care on caregivers. Early identification of the HRQoL of caregivers will not only benefit the caregivers but also the child they are caring for as the HRQoL of caregivers impacts on the QoL of the child with FSD.

Objective: The purpose of this study was to determine the characteristics, assessment, and treatment of infants with Neonatal Abstinence Syndrome (NAS) as perceived by Speech-Language Pathologists (SLP) and whether it differed from those of other Neonatal Intensive Care Unit populations. Methods: A secure web-based questionnaire with 62 questions collected information on NAS, caseloads, treatment environment, and demographics. Twenty-six respondents initiated the survey; 42% completed most or all questions. Response analyses included descriptive and nonparametric inferential statistics. Results: Infants with NAS were on the caseloads of 73% of respondents. The majority (79%) only saw infants with NAS and feeding problems. Primary problems included incomplete or increased time to complete feeds, increased/excessive/irregular sucking rates, and reflux. Working on teams, respondents provided assessment, treatment, and education of infant feeding and state. Conclusion: Growing demand for SLP intervention with infants with NAS is likely to persist if opioid use continues to increase as projected.

Background: Preterm infants and neonates may present with dysphagia due to immaturity or the presence of medical conditions. Enteral feeds are used to ensure optimal nutrition is achieved while the neonates are developing appropriate oral feeding skills. Varied interventions may be used to transition neonates to full oral feeds as oral feeding is often a prerequisite for discharge from hospital. Aims: The main aim of this study was to summarize, interpret and analyse the literature on the different interventions used for the transition to full oral feeds in preterm infants and neonates to identify research gaps and to inform clinical practice on the best intervention options. A secondary aim was to validate the findings of the scoping review for the South African context. Methods: A scoping review was conducted. Relevant studies were identified by searching six databases, Google and Google scholar. Inclusion criteria included studies written in English, peer reviewed and published between 1998–2018, that described the interventions used to transition preterm infants and neonates to full oral feeds. Data were extracted from the articles using a data charting form and analysed descriptively and thematically. The findings were shared with health care professionals who work with premature infants and neonates who then participated in a semi-structured interview to provide feedback relevant to the South African context. Results: Forty-seven articles were included. Six broad intervention categories were identified: oral-motor, oral-sensory, other senses, timing, cue-based and utensils. Non-nutritive sucking (NNS) interventions were reported most frequently across single and combined interventions. Outcome measures reported included: time taken to full oral feeds, earlier hospital discharge, long-term feeding outcomes, weight and sucking proficiency. Improved outcomes were associated with NNS and NNS with oral stimulation. Nine health care professionals were interviewed. They confirmed using a number of the interventions, with NNS reported the most. Health care professionals also provided insight into the challenges of implementing some interventions due to limited resources and staffing in the South African context. Conclusions: There are a range of interventions reported in the literature and many of them are used in South Africa. Positive outcomes such as earlier transition to full oral feeds; earlier hospital discharge; improved weight gain and improved sucking proficiency have been reported with NNS and combined NNS and Oral Stimulation interventions, however further studies are needed.

Neonatal abstinence syndrome (NAS) refers to the withdrawal infants exposed to opioids in utero may experience following birth. In recent years, the number of infants born who present with NAS has grown exponentially. This increase in the number of infants with NAS has led to a new population within the caseloads of speech-language pathologists (SLPs) who work in neonatal intensive care units (NICUs). SLPs’ knowledge base and skill set of assessment and treatment of swallowing and feeding disorders in infancy play a vital role in the treatment of infants with NAS in the NICU. A dearth of research exists regarding the specific nature of the feeding problems and skills of infants with NAS and whether SLP intervention for infants with NAS needs to differ from that of other infant NICU populations. Identifying how SLPs can best serve infants with NAS in the NICU is essential to their immediate well-being as well as the development of these infants. The purpose of this survey-based research study was to examine NICU SLPs’ perceptions of infants with NAS, and more specifically, how NAS affects the infants’ feeding skills, structural, and oral-motor characteristics. A questionnaire was developed based on an in-depth literature review to collect information on NAS, caseloads, treatment environment, and respondent demographics. The survey consisted of three sections: NAS (further divided into Assessment, Treatment, and Education), Environmental Description, and Respondent Demographics. The secure web-based questionnaire was distributed through SurveyMonkey™, an online survey platform. Survey research was conducted, and hospital-based speech-language pathologists within the USA acted as respondents. The findings will contribute to establishing a preliminary base of information on this topic. The results are expected to further inform the field as well as current practices in evidenced-based practice care for infants with NAS.

Introduction: To date, few research studies have evaluated pediatric feeding and swallowing practices in school systems across the United States. This study aims to i) understand the factors that impact a speech-language pathologists (SLPs) level of comfort in providing these services, ii) to identify barriers to service provision, iii) develop a concrete understanding of a SLPs role in providing feeding and swallowing services in a school setting, and iv) to identify the types of service suggested by school-based SLPs in response to a fictional case study. Methods: School-based SLPs and clinical fellows were invited to participate in a 10-15 minute web-based survey. The survey questions focused on basic demographic information, vocational history, barriers to treatment, and clinician comfort level. In addition, survey respondents were asked to develop a treatment plan in response to a fictional case study. In total, 200 anonymous survey responses were collected and analyzed. Results: Descriptive data, summarizing the demographic and vocational factors of the survey respondents, are provided. In addition, independent Pearson Chi-Square analyses were performed to determine the degree of association between the demographic/vocational factors and the SLPs self-reported comfort level. The results of these correlation analyses are reported and discussed. Barriers to dysphagia management and a summary of the services currently provided in the school setting are discussed from the perspective of professional practice issues. Analysis of the case study results indicated a wide range of treatment plans. The most common type of direct intervention suggested was an oral motor exercise regime, followed by diet modifications and the implementation of safe swallow strategies. Discussion: The survey results indicate a number of factors impact clinician comfort level including geographic region, previous medical experience and current service provision. A number of barriers to practice were identified which include academic and/or clinical preparedness and concerns related to the educational relevance of service. Approximately 26.5% of survey respondents indicated that there were providing feeding and swallowing related services in a school setting with 98.1 % of these clinicians providing collaborative consultation. The case study results highlighted the variability in treatment approaches.

This survey research explores neonatal intensive care unit speech-language pathologists’ perceptions of infants with neonatal abstinence syndrome; specifically, how NAS affects infants’ feeding skills, along with structural and oral-motor characteristics. The findings of this research will contribute to this population’s information base. The results are expected to inform the field and current evidence-based practice care for infants with NAS.Learner Outcome(s): Explain Neonatal Abstinence Syndrome (NAS) Describe infants with NAS and how NAS affects the infants’ feeding skills from the perspective of Neonatal Intensive Care Unit (NICU) Speech-Language Pathologists (SLPs) Identify how SLPs in the NICU participate in intervention for infants with NAS and their families